Second Chance Support Services LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SECOND CHANCE SUPPORT SERVICES LLC

Practice address

22 E Church St Ste 319
Martinsville, VA 24112-6208

Phone

(276) 403-5084

Fax

(276) 403-4207

NPI assigned

Feb 4, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Kelly Robinson Eanes

Title

Executive Director

Phone

(434) 203-7538

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1245795269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 E CHURCH ST STE 318",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241126208",
            "telephone_number": "276-403-5084",
            "fax_number": "276-403-4207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 E CHURCH ST STE 319",
            "city": "MARTINSVILLE",
            "state": "VA",
            "postal_code": "241126208",
            "telephone_number": "276-403-5084",
            "fax_number": "276-403-4207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SECOND CHANCE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-04",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "EANES",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "ROBINSON",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "434-203-7538",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE CORPORATION COMMISSION",
            "identifier": "S5590577",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexis Rae Schoch, PHARM D
• Tracey Scott Harris
• David W Seamon, MD
• Wendy Seamon, PT
• Bobbie Jo Seamster, LPC
• Second Chance, LLC
• Second to Nature Boutique, LLC
• Amy Mays Seidle, LPTA
• Kathryn Cabot Self, MD
• John William Selman, M.D.

• Community/Behavioral Health Agency in Martinsville, VA
• Providers in Martinsville, VA by specialty
• Community/Behavioral Health Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.